ABSTRACT
Objetivo: El objetivo fue desarrollar un cribado de detección de cardiopatías en atención primaria, para identificar alteraciones electrocardiográficas patológicas y cardiopatías subyacentes en adolescentes. Diseño: Durante un año se realizó el estudio mediante muestreo polietápico. Lugar: Se seleccionaron los centros asistenciales de atención primaria en un área de salud, que dispusieran de equipo de electrocardiograma (ECG) digital (12 centros). Participantes: Inicialmente, se reclutó a 718 (16,6%) adolescentes de 14 años y se excluyeron a los que tenían un diagnóstico de cardiopatía previo. Intervención: El cribado consistió en incluir en la revisión obligatoria de los 14 años un cuestionario de salud y un ECG. Principales medidas: Para el cribado se realizó cuestionario, auscultación cardíaca, ECG y ecocardiografía. Se establecieron criterios de anormalidad para remitir a una segunda valoración por un cardiólogo. Resultados: Finalmente la muestra la componen 698 adolescentes, con una edad media de 13,7± 0,5 años, de los cuales 354 (50,7%) fueron chicos. Fueron seleccionados 149 (21,3%) para la segunda revisión por cardiología: 88 (12,6%) por cuestionario positivo, 11 (2,2%) por auscultación cardíaca anormal y 66 (9,5%) por hallazgos en ECG. Los adolescentes con evidencia de cardiopatía fueron 24 (3,4%). De ellos, 14 (2,0%) tuvieron alteraciones sugestivas y se les recomendó seguimiento, 6 (0,9%) tuvieron diagnóstico definitivo de cardiopatía y 4 (0,6%) tenían otros hallazgos patológicos relacionados con el sistema cardiovascular. Conclusiones: El cribado permitió identificar un 1% de adolescentes con cardiopatía y otro 2% permanecerá en seguimiento. El ECG detectó más casos patológicos que el cuestionario.(AU)
Objective: The objective was to develop a screening for heart disease detection in primary care, to identify pathological electrocardiographic changes and underlying heart disease in adolescents. Design: The study was carried out for one year using multistage sampling. Site: Primary care centers in a health area that had digital ECG equipment (12 centers) were selected. Participants: Initially, 718 (16.6%) 14-year-old adolescents were recruited and those with a previous diagnosis of heart disease were excluded. Interventions: Screening consisted of including a health questionnaire in the mandatory 14-year-old check-up. Main measurements: Screening included a questionnaire, cardiac auscultation, ECG and echocardiography. Abnormality criteria were established to refer for a second evaluation by a cardiologist. Results: Finally, the sample was made up of 698 adolescents, with a mean age of 13.7±0.5 years, and 354 (50.7%) were boys. A total of 149 (21.3%) were selected for a second review by cardiology: 88 (12.6%) due to a positive questionnaire, 11 (2.2%) due to abnormal cardiac auscultation, and 66 (9.5%) due to ECG findings. Adolescents with evidence of heart disease were 24 (3.4%). Of these, 14 (2.0%) had suggestive alterations and follow-up was recommended, 6 (0.9%) had a definitive diagnosis of heart disease, and 4 (0.6%) had other pathological findings related to the cardiovascular system. Conclusions: The screening allowed us to identify 1% of adolescents with heart disease and another 2% will remain in follow-up. The ECG detected more pathological cases than the questionnaire.(AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Heart Diseases , Primary Health Care , Electrocardiography , Mass Screening , Death, Sudden, Cardiac , Prospective Studies , Spain , Surveys and QuestionnairesABSTRACT
OBJECTIVE: The objective was to develop a screening for heart disease detection in primary care, to identify pathological electrocardiographic changes and underlying heart disease in adolescents. DESIGN: The study was carried out for one year using multistage sampling. SITE: Primary care centers in a health area that had digital ECG equipment (12 centers) were selected. PARTICIPANTS: Initially, 718 (16.6%) 14-year-old adolescents were recruited and those with a previous diagnosis of heart disease were excluded. INTERVENTIONS: Screening consisted of including a health questionnaire in the mandatory 14-year-old check-up. MAIN MEASUREMENTS: Screening included a questionnaire, cardiac auscultation, ECG and echocardiography. Abnormality criteria were established to refer for a second evaluation by a cardiologist. RESULTS: Finally, the sample was made up of 698 adolescents, with a mean age of 13.7±0.5 years, and 354 (50.7%) were boys. A total of 149 (21.3%) were selected for a second review by cardiology: 88 (12.6%) due to a positive questionnaire, 11 (2.2%) due to abnormal cardiac auscultation, and 66 (9.5%) due to ECG findings. Adolescents with evidence of heart disease were 24 (3.4%). Of these, 14 (2.0%) had suggestive alterations and follow-up was recommended, 6 (0.9%) had a definitive diagnosis of heart disease, and 4 (0.6%) had other pathological findings related to the cardiovascular system. CONCLUSIONS: The screening allowed us to identify 1% of adolescents with heart disease and another 2% will remain in follow-up. The ECG detected more pathological cases than the questionnaire.
Subject(s)
Death, Sudden, Cardiac , Heart Diseases , Male , Humans , Adolescent , Female , Death, Sudden, Cardiac/prevention & control , Electrocardiography , Heart Diseases/diagnosis , Echocardiography , Mass ScreeningABSTRACT
Enmarcado dentro del proyecto "Indicadores de calidad en endoscopia digestiva", liderado por la Sociedad Española de Patología Digestiva (SEPD), el objetivo es proponer los procedimientos e indicadores de estructura, proceso y resultado necesarios para aplicar y evaluar la calidad en la enteroscopia. Para ello, se ha realizado una búsqueda de indicadores de calidad en enteroscopias. La calidad de la evidencia se ha analizado aplicando la escala de clasificación utilizada en GRADE (Grading of Recommendations Assessment, Development and Evaluation) definiéndola como de calidad alta, moderada, baja y muy baja. Se ha identificado para enteroscopia un total de 10 indicadores de procesos (uno de preprocedimiento, ocho de procedimiento y uno de resultado), siendo los más importantes la indicación adecuada y la elección de una vía de acceso idónea
No disponible
Subject(s)
Humans , Quality Indicators, Health Care , Balloon Enteroscopy/standards , Balloon Enteroscopy/methodsABSTRACT
Within the project "Quality Indicators in Gastrointestinal Endoscopy," under the leadership of the Sociedad Española de Patología Digestiva (SEPD), our goal is to propose the procedures and the structure, process, and outcome indicators required for the application and assessment of quality in enteroscopy. To this end a search was performed for quality indicators in enteroscopy. Quality of evidence was measured by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system, and classified as high, moderate, low, and very low. A total of 10 process indicators (one preprocedure, eight procedure, one postprocedure) were identified for enteroscopy, with appropriate indication and choice of most efficient route being most significant.
Subject(s)
Laparoscopy , Quality Indicators, Health Care , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage , HumansABSTRACT
INTRODUCCIÓN: Contar con documentos de consentimiento informado (DCI) de calidad implica que la información pueda ser comprendida y asimilada por el paciente. El propósito de este estudio es evaluar y mejorar la facilidad de comprensión de los DCI presentados para su acreditación en un hospital de tercer nivel. MÉTODOS: Estudio de evaluación y mejora de la calidad de 132 DCI provenientes de 2 servicios de un hospital público de tercer nivel, estructurado en 3 fases: evaluación inicial, intervención y reevaluación. Se utilizaron 2 criterios: extensión (deseable inferior a 490 palabras) e índice de legibilidad INFLESZ (adecuado si >55 puntos), tanto del DCI completo como de cada uno de sus apartados. Los contenidos propuestos por los servicios fueron adaptados por una persona entrenada no sanitaria, cuyas dudas sobre términos médicos fueron resueltas por los autores. Para comparar los resultados entre evaluaciones se calcularon mejoras relativas en extensión e INFLESZ, y su significación estadística. RESULTADOS: Antes de la intervención, el 78,8% de los DCI eran de extensión deseable (IC 95%: 86,5-71,1) con un INFLESZ medio de 44,1 puntos (3,8% > 55 puntos) (IC 95%: 6,0-1,6). Tras ella, el INFLESZ fue de 61,9 puntos (mejora relativa 40,3%, p < 0,001), con el 100% > 55. Los DCI resultantes dedican una mayor extensión a describir la naturaleza del procedimiento (p < 0,0001) y menor a consecuencias, riesgos (p < 0,0001) y alternativas (p < 0,05). CONCLUSIONES: Introducir dinámicas de mejora en el diseño de DCI es posible y necesario, ya que produce DCI de mayor calidad y más fáciles de comprender por los pacientes
INTRODUCTION: The information contained in a good informed consent form (ICF) must be understood by the patients. The aim of this study is to assess and improve the readability of the ICF submitted for accreditation in a tertiary hospital. METHODS: Study of assessment and improvement of the quality of 132 ICF from 2 departments of a public tertiary hospital, divided into 3 phases: Initial assessment, intervention and reassessment. Both length and readability are assessed. Length is measured in words (adequate to 470, excessive over 940), and readability in INFLESZ points (suitable if over 55). The ICF contents initially proposed by departments were adapted by non-health-related trained persons, whose doubts about medical terms were resolved by the authors. To compare results between evaluations, relative improvement (in both length and INFLESZ) and statistical significances were calculated. RESULTS: Baseline data: 78.8% of the ICFs showed a desired length (CI95% 86,5-71,1) and a mean of 44.1 INFLESZ points (3.8% >55 points, CI95% 6,0-1,6). After the intervention, INFLESZ raised to 61.9 points (improvement 40.3%, P<.001), all ICF showing >55 points. The resulting ICFs had a longer description of the nature of the procedure (P<.0001) and a shorter description of their consequences, risks (P <.0001) and alternatives (P <.05). CONCLUSIONS: The introduction of improvement dynamics in the design of ICFs is possible and necessary because it produces more effective and easily readable ICFs
Subject(s)
Consent Forms , Informed Consent , Comprehension , Epidemiological Monitoring/trends , Hospital Accreditation , Quality of Health Care , Hospitals, Public , Evaluation Studies as Topic , Spain/epidemiologyABSTRACT
INTRODUCTION: Stroke is a serious but potentially reversible entity. Reducing the time of care in the acute phase is essential to limit morbidity and mortality. The evaluation of the performances in stroke care is essential because it allows identify opportunities for improvement. AIM: To understand and analyze the determinants of the delay in the time of hospital care for the subsequent implementation of a cycle of improvement. PATIENTS AND METHODS: Retrospective study of patients with acute ischemic stroke treated with intravenous thrombolysis (IVT) and/or intra-arterial mechanical thrombectomy (IAMT) in a tertiary hospital between 2009-2014. In-hospital times, quality indicators and associated factors were analyzed. RESULTS: 337 patients with acute ischemic stroke were treated with IVT (66.2%) and/or IAMT (54.1%). In-hospital times (95% confidence interval): door-to-needle time, 75.88 min (71.67-80.16 min); door-to-imaging, 43.27 min (40.17-46.37 min), imaging-to-needle, 38.01 min (34.08-41.93 min); IVT-IAMT time, 127.44 min (108.7-146.18 min); door-to-groin puncture, 155.22 min (140.03-170.40 min). 36.6% treated in less than 60 min, neuroimaging in less than 25 min in 19.9% and IVT-IAMT time in less than 90 minutes in 28.8%. Age, onset-to-door time, non-ambulance transport and the learning period were identified as determinants. CONCLUSIONS: Knowledge of the current situation of the times and quality indicators and their determinants are essential to provide the motivation to start an initiative to improve the quality of care in patients with acute stroke.
TITLE: Identificacion de los factores condicionantes de tiempos e indicadores de calidad en la atencion intrahospitalaria al ictus agudo.Introduccion. El ictus es una entidad grave, pero potencialmente reversible. La reduccion del tiempo de atencion en el momento agudo es fundamental para limitar la morbimortalidad. La evaluacion de las actuaciones en la atencion al ictus es esencial, porque permite identificar oportunidades de mejora. Objetivo. Conocer y analizar los factores condicionantes de la demora en los tiempos de atencion intrahospitalaria para la posterior implementacion de un ciclo de mejora. Pacientes y metodos. Estudio retrospectivo de pacientes con ictus isquemico agudo tratados con trombolisis intravenosa (TLIV) y/o trombectomia intraarterial mecanica (TIAM) en un hospital terciario entre 2009-2014. Se analizaron los tiempos intrahospitalarios, los indicadores de calidad y sus factores condicionantes. Resultados. Un total de 337 pacientes fueron tratados con TLIV (66,2%) y/o TIAM (54,1%). Tiempos medios de actuacion (intervalo de confianza al 95%): puerta-TLIV, 75,88 min (71,67-80,16 min); puerta-TC, 43,27 min (40,17-46,37 min); TC-TLIV, 38,01 min (34,08-41,93 min); TLIV-TIAM, 127,44 min (108,7-146,18 min); puerta-TIAM, 155,22 min (140,03-170,4 min). El 36,6% fue tratado en menos de 60 min, la neuroimagen se realizo en menos de 25 min en un 19,9% y el tiempo TLIV-TIAM fue menor de 90 min en un 28,8%. La edad, el tiempo inicio-puerta, la procedencia de otro hospital y el periodo de aprendizaje se identificaron como factores condicionantes. Conclusiones. El conocimiento de la situacion actual de los tiempos e indicadores intrahospitalarios y sus factores condicionantes son el punto de partida y proporcionan la motivacion necesaria para impulsar una iniciativa para la mejora de la calidad asistencial en el paciente con ictus agudo.
Subject(s)
Mechanical Thrombolysis , Stroke/therapy , Thrombolytic Therapy , Time-to-Treatment , Adolescent , Adult , Aged , Aged, 80 and over , Emergency Service, Hospital/statistics & numerical data , Female , Fibrinolytic Agents , Hospitalization , Hospitals, University/statistics & numerical data , Humans , International Classification of Diseases , Male , Middle Aged , Neuroimaging , Neurologic Examination , Patient Transfer/statistics & numerical data , Quality Indicators, Health Care , Retrospective Studies , Spain , Stroke/diagnosis , Stroke/drug therapy , Tertiary Care Centers/statistics & numerical data , Young AdultABSTRACT
INTRODUCTION: The information contained in a good informed consent form (ICF) must be understood by the patients. The aim of this study is to assess and improve the readability of the ICF submitted for accreditation in a tertiary hospital. METHODS: Study of assessment and improvement of the quality of 132 ICF from 2 departments of a public tertiary hospital, divided into 3 phases: Initial assessment, intervention and reassessment. Both length and readability are assessed. Length is measured in words (adequate to 470, excessive over 940), and readability in INFLESZ points (suitable if over 55). The ICF contents initially proposed by departments were adapted by non-health-related trained persons, whose doubts about medical terms were resolved by the authors. To compare results between evaluations, relative improvement (in both length and INFLESZ) and statistical significances were calculated. BASELINE DATA: 78.8% of the ICFs showed a desired length (CI95% 86,5-71,1) and a mean of 44.1 INFLESZ points (3.8% >55 points, CI95% 6,0-1,6). After the intervention, INFLESZ raised to 61.9 points (improvement 40.3%, P<.001), all ICF showing >55 points. The resulting ICFs had a longer description of the nature of the procedure (P<.0001) and a shorter description of their consequences, risks (P <.0001) and alternatives (P <.05). CONCLUSIONS: The introduction of improvement dynamics in the design of ICFs is possible and necessary because it produces more effective and easily readable ICFs.
Subject(s)
Informed Consent , Comprehension , Humans , Tertiary Care CentersABSTRACT
Introducción. El ictus es una entidad grave, pero potencialmente reversible. La reducción del tiempo de atención en el momento agudo es fundamental para limitar la morbimortalidad. La evaluación de las actuaciones en la atención al ictus es esencial, porque permite identificar oportunidades de mejora. Objetivo. Conocer y analizar los factores condicionantes de la demora en los tiempos de atención intrahospitalaria para la posterior implementación de un ciclo de mejora. Pacientes y métodos. Estudio retrospectivo de pacientes con ictus isquémico agudo tratados con trombólisis intravenosa (TLIV) y/o trombectomía intraarterial mecánica (TIAM) en un hospital terciario entre 2009-2014. Se analizaron los tiempos intrahospitalarios, los indicadores de calidad y sus factores condicionantes. Resultados. Un total de 337 pacientes fueron tratados con TLIV (66,2%) y/o TIAM (54,1%). Tiempos medios de actuación (intervalo de confianza al 95%): puerta-TLIV, 75,88 min (71,67-80,16 min); puerta-TC, 43,27 min (40,17-46,37 min); TC-TLIV, 38,01 min (34,08-41,93 min); TLIV-TIAM, 127,44 min (108,7-146,18 min); puerta-TIAM, 155,22 min (140,03-170,4 min). El 36,6% fue tratado en menos de 60 min, la neuroimagen se realizó en menos de 25 min en un 19,9% y el tiempo TLIVTIAM fue menor de 90 min en un 28,8%. La edad, el tiempo inicio-puerta, la procedencia de otro hospital y el período de aprendizaje se identificaron como factores condicionantes. Conclusiones. El conocimiento de la situación actual de los tiempos e indicadores intrahospitalarios y sus factores condicionantes son el punto de partida y proporcionan la motivación necesaria para impulsar una iniciativa para la mejora de la calidad asistencial en el paciente con ictus agudo (AU)
Introduction. Stroke is a serious but potentially reversible entity. Reducing the time of care in the acute phase is essential to limit morbidity and mortality. The evaluation of the performances in stroke care is essential because it allows identify opportunities for improvement. Aim. To understand and analyze the determinants of the delay in the time of hospital care for the subsequent implementation of a cycle of improvement. Patients and methods. Retrospective study of patients with acute ischemic stroke treated with intravenous thrombolysis (IVT) and/or intra-arterial mechanical thrombectomy (IAMT) in a tertiary hospital between 2009-2014. In-hospital times, quality indicators and associated factors were analyzed. Results. 337 patients with acute ischemic stroke were treated with IVT (66.2%) and/or IAMT (54.1%). In-hospital times (95% confidence interval): door-to-needle time, 75.88 min (71.67-80.16 min); door-to-imaging, 43.27 min (40.17-46.37 min), imaging-to-needle, 38.01 min (34.08-41.93 min); IVT-IAMT time, 127.44 min (108.7-146.18 min); door-to-groin puncture, 155.22 min (140.03-170.40 min). 36.6% treated in less than 60 min, neuroimaging in less than 25 min in a 19.9% and IVT-IAMT time in less than 90 minutes in 28.8%. Age, onset-to-door time, non-ambulance transport and the learning period were identified as determinants. Conclusions. Knowledge of the current situation of the times and quality indicators and their determinants are essential to provide the motivation to start an initiative to improve the quality of care in patients with acute stroke (AU)
Subject(s)
Humans , Male , Female , Stroke/epidemiology , Stroke/rehabilitation , Length of Stay/statistics & numerical data , Length of Stay/trends , Thrombolytic Therapy/methods , Thrombectomy/methods , Thrombectomy , Indicators of Health Services/organization & administration , Indicators of Health Services/standards , Indicators of Health Services/statistics & numerical data , Indicators of Quality of Life , Indicators of Morbidity and Mortality , Time Factors , Confidence IntervalsABSTRACT
No disponible
